Healthcare Provider Details

I. General information

NPI: 1760955991
Provider Name (Legal Business Name): EMILY BURGIO HINES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY KATE BURGIO RN

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

706 METHODIST RD
WESTBROOK ME
04092-3211
US

V. Phone/Fax

Practice location:
  • Phone: 205-541-4113
  • Fax:
Mailing address:
  • Phone: 205-541-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN58850
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP101021
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: